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Cheap capital, predatory pricing and death

As Drug Prices Rise, Is Boston’s Prosperity Based On A Moral Crime?

Prescription drug prices have become a high-profile issue, with a growing clamor from politicians, including Massachusetts Gov. Charlie Baker, seeking to take action. There are many laudable elements in Baker’s proposal to negotiate prices directly with drug makers, despite its narrow focus, but such efforts are doomed to become little more than window dressing. We have a much bigger problem to confront.

The week before Thanksgiving, in the freezing rain, a group of patients, nurses, physicians and activists, organized by the Right Care Alliance, marched on the Sanofi drug company in Cambridge, Massachusetts. Sanofi had been marking up its insulin products by as much as 4,500 percent over to the estimated cost of producing a single vial — and people with type 1 diabetes were starting to die. Led by grieving mothers, we carried the ashes of their children to the insulin manufacturer demanding it cut its prices.

I have sympathy for Sanofi employees, and even the company’s management. They are in a difficult, contradictory spot, enticed by well-paying jobs and the promise of doing good in the world – after all, the company’s drugs can sometimes save lives.

But we all need to face up to the real-world consequences of drug pricing practices. That’s not a comfortable thing to do, not for the people who work for drug companies, nor for those of us who are prospering in the “innovation economy.”

There is a story told often here in Massachusetts: The Commonwealth’s economy has boomed, just like Silicon Valley’s, because of a rich ecosystem of startups, intrepid entrepreneurs, savvy venture investors and talented scientists and technologists. Our colleges and universities attract the brightest students from around the world, and their close relationships to industry fuel economic growth.

There is indisputable truth in that story. But there is also an ugly lie at its heart.

The pharma sector, the pride of Massachusetts, is a bubble fed by astronomical, obscene profits. It’s not the innovative ideas, though there are many of those, nor the “best and the brightest” young scientists, though they can be dazzling in their smarts, that are making the biotech sector boom. It’s the recent access to cheap capital and even cheaper hype. And predatory pricing.

The companies that have put down roots here to take advantage of our educated elite – Sanofi, Eli Lilly, Novartis and scores of others – have continued the pattern made famous by Martin Shkreli, the CEO who dramatically hiked the price of several drugs, and is now serving jail time for defrauding investors. Companies today are setting prices to whatever the market will bear, no matter the damage. And we praise their ingenuity for bringing innovation to patients – and dollars to their shareholders.

But what kind of economic miracle routinely depends on the FDA to approve cancer drugs that are unproven when it comes to prolonging life, yet cost more than $100,000 for a course of treatment? What kind of economic miracle leads to people dying because they can’t afford an essential medicine like insulin, which has been around for almost a century?

Antavia Lee Worsham, Alec Raeshawn Smith, Shane Boyle and Jesse Lutgen, four people with type 1 diabetes, died because they couldn’t afford insulin.

People with type 1 diabetes need insulin to stay alive, like all of us need water. When insulin was first purified by Canadian scientists Frederick Banting and Charles Best in 1921, they instantly knew it was a life-saving miracle, an essential medication. The phrase “greed is good” from the movie “Wall Street,” which signaled the start of our recent era of hypercapitalism, wasn’t part of their lexicon: they sold their rights for $1 each to make sure everyone could afford it.

Now the price of insulin is out of reach for anyone paying out of pocket, and it is one more thing driving up insurance premiums and deductibles for everyone else.

For those of us who live in Boston, in what the author Thomas Frank has called “the spiritual homeland of America’s professional class,” it’s time for sober reflection. When “innovation” becomes an empty mantra for extortionate pricing, we should all agree that it’s time for a rethink.

I’m not saying it will be simple. From the first social movements like the abolitionists, who found an early home in Massachusetts, to tackling big tobacco or the fossil fuel industry, economic interests almost always cloud moral judgements and make change incredibly slow and difficult.

But what if Massachusetts’ current economic miracle is based on a moral crime?

What else are we to call it when the preferred business model is starting to kill people?

No fair-minded observer would say that we have a functioning market for pharmaceuticals. Instead, we have an organized syndicate of insurance companies, manufacturers and benefits managers, feeding off the vulnerability of the sick and the weak. As a society, we have sacrificed our own — we sacrificed Antavia, Alec, Shane, and Jesse — on the altar of the church of market fundamentalism. To defend this kind of market is a form of idolatry. And it demands that we ask of ourselves: what are we compelled to do for the well-being of all?

The Right Care Alliance felt compelled to take action at Sanofi because no one else seems willing to state this problem in its stark, unvarnished reality. As a society, we need patent laws reformed and serious government intervention to control prices. Yes, we need to bestow reasonable rewards on true innovators who invent effective drugs that bring real health to patients. But we also need a new system to crack down on speculators and profiteers.

From our political leaders we can no longer tolerate half-measures; we need deeds that match the seriousness of the problem, because people are dying. Massachusetts’ prosperity must be reestablished on a sound moral foundation. Otherwise history will not judge us kindly.

Vikas Saini, MD, is a cardiologist, the president of the Lown Institute and co-chair of the Right Care Alliance, a clinician and patient led health care reform movement.

Comment:

By Don McCanne, M.D.

We, the people, can do something about this. We can establish a sound moral foundation by demanding the enactment and implementation of Single Payer Medicare for All – a system that ensures equitable and affordable health care for everyone. If we fail to do this, we share the blame for the ugly lie at the heart of our health care system – the moral crime wherein the preferred business model is killing people.